General Surgery, Costs and Cost Analysis Clinical Trial
Official title:
Evaluating the Impact of Health Insurance on Financial Risk Protection for Surgical Care: an Analysis of Ghana' Insurance Scheme at Korlebu Teaching Hospital
Ghana, a Low-Middle Income Country (LMIC) situated in the heart of West Africa started a national health insurance scheme in 2003.The scheme was designed to provide a comprehensive benefit package inclusive of surgical care and to protect against the need to pay out of pocket at the point of service. As of 2013, close to 40% of the population of Ghana was actively enrolled and ongoing plans to expand coverage by the government. This study tests the extent to which the national health insurance scheme of Ghana provides financial risk protection against catastrophic payments as a result of access to surgical care.
It is estimated that 11%-33% of the global burden of disease is attribute to surgical
conditions. Yet, globally 3.7 billion people face financial catastrophe if surgical care is
needed. Ghana, a country of 27 million people has a 14-year experience with a national health
insurance scheme (NHIS) that provides coverage for 95% of the health conditions afflicting
Ghanaians and includes access to surgical care. Despite much progress in providing Universal
Health Coverage through NHIS, prior work shows that up to 18% of insured households make
catastrophic health payments for routine care which is largely unaffordable for the poor.
Particularly in Ghana where 1 out of 4 individuals live on less than 1.25 dollars per day.
More importantly in 2015, the Lancet Commission on Global Surgery called for national
surgical plans that provide 100% coverage against catastrophic health expenditures as a
result of seeking surgical care.
The premise of Dr. Okoroh's GloCal project is to describe the surgical conditions that are
included in the health insurance scheme and to evaluate whether insurance protect surgical
patients against catastrophic health payments through a single institutional review at
Korle-bu Teaching Hospital. With this work she hopes to develop a set of recommendations to
the ministry of health and the national health insurance authority on how to improve
health-care financing for surgical care in Ghana.
Early results of our study show that NHIS provides coverage for most common surgical
conditions including symptomatic hernia, breast cancer, and appendicitis. 70% of the total
cost of surgical care was covered by NHIS, yet 56% of insured individuals made catastrophic
payments for surgical care. Surgery is unaffordable as on average insured individuals spent
close to 40% of their annual income on surgical care. Particularly the coverage of medicines,
supplies, imaging, and other ancillary services are sparse which are necessary to the
provision of surgical care. Our recommendations include; NHIS increasing the proportion of
the total cost of surgical care covered for the poor and addressing the gaps in coverage of
ancillary services. Further work includes understanding how households economically cope with
making payments and the contribution of borrowing and other financing mechanisms in reducing
the burden of cost. Our new study characterizes the cost of trauma care which is a major
source of disability and injury for young adults in Ghana. Efforts are being made to engage
policymakers on healthcare reform in Ghana.
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